Prediction of Fractures After Open Wedge High Tibial Osteotomy Based on the Distance From the Tibial Osteotomy Point to the Medial Edge of the Tibia

Abstract

ObjectiveTo investigate the relationship between the distance from the medial tibial osteotomy point to the medial tibial edge and the development of lateral tibial hinge fracture (type II) and intra-articular tibial plateau fracture (type III) in patients who have degenerative disease undergoing open wedge high tibial osteotomy (OWHTO). This information will aid surgeons in avoiding the occurrence of fractures. MethodsThis retrospective study analyzed 304 patients who underwent OWHTO from January 2018 to January 2024 in the Affiliated Hospital of Qingdao University. The distance from the tibial osteotomy point to the medial tibial edge on imaging was analyzed to determine its association with fracture. A one-way analysis of variance was used to compare the differences in height, weight, body mass index (BMI), the distance from the medial tibial osteotomy point to the medial tibial edge, sex, left and right sides of the knee, and osteoporosis in the occurrence of type II and type III fractures. Receiver operating characteristic curves were used to identify the critical distances associated with type II and type III fractures. Logistic regression analysis was used to obtain the odds ratio (OR) of the critical distance adjusted for age, sex, left and right sides, BMI, and T value. ResultsThere were 40 fractures (13.3%) in 304 patients after OWHTO, comprising 21 type II fractures (7.0%) and 19 type III fractures (6.3%). A single-factor variance analysis showed that the tibial bone cutting distance to the medial tibial edge (P = 0.02) and osteoporosis (P = 0.01) were significantly different from the fracture. Receiver operating characteristic curves showed that the critical distances for type II and type III fractures were 40.5 and 47.1 mm, respectively. Logistic regression analysis showed that the ORs of type II and type III fractures were 1.061 (95% CI [confidence interval] = 1.010 to 1.115) and 1.064 (95% CI = 1.011 to 1.119), respectively. ConclusionIn patients undergoing OWHTO, the risk factors for type II and III fractures are osteoporosis and the distance from the tibial bone cutting point to the medial tibial edge. This distance should be minimized during OWHTO to avoid type II and III fractures.